JC wrote last night as he got kicked in the balls by the world:
Do you have any idea how hard it is to deal with addiction and get treatment in America? I have gold plated insurance, am comfortably middle class, and I have been going through sheer hell trying to get into a facility. It’s almost like you have to show up with a syringe full of heroin dangling from your arm and a crack pipe in your mouth to get anyone to take you seriously…
Why is this so fucking hard? Am I just incompetent or is it this fucking bad everywhere?…Why is it that getting into rehab requires a fucking PhD in bullshit and the equivalent of a tax attorney’s knowledge of procedure? Isn’t getting clean tough enough? Jeebus
There are a couple of things in play. The first and biggest reason why JC is getting fucked over hard right now is that there are nowhere near enough rehab beds in this country. Most of this is historical in two aspects.
The first is that addictive diseases are now seen as medical issues with significant mental health components. Any other physical health problem would see it treated and paid for as a physical health problem. However diseases of addiction were long seen to be either mental health problems with minimally related physical health problems, or solely a matter of someone needing to sack up. That was the attitude when health insurance started to propogate. Early health insurance had minimal to no mental health coverage, and over the course of the past sixty years, mental health coverage was both slowly added to coverage and poorly paid.
The big policy change on this matter was the 2008 Mental Health Parity and Addiction Equity Act. This act required policies that cover groups of more than fifty (50) people to pay for mental health and recovery services at the same benefit level and same accessibility standards as any other physical health act. A side effect of the act is that providers in this field are slowly starting to see their commercial rates rise. Over the long term, this should mean more beds will be available. PPACA has a couple of policy changes that will decrease the degree of fucking over as well.
The other major policy driving that contributed to John being fucked over this year is the Medicaid Institutions for Mental Diseases exclusion policy:
The IMD exclusion is found in section 1905(a)(B) of the Social Security Act, which prohibits “payments with respect to care or services for any individual who has not attained 65 years of age and who is a patient in an institution for mental diseases” except for “inpatient psychiatric hospital services for individuals under age 21.” The law goes on to define “institutions for mental diseases” as any “hospital, nursing facility, or other institution of more than 16 beds [my emphasis], that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.” The IMD exclusion was intended to ensure that states, rather than the federal government, would have principal responsibility for funding inpatient psychiatric services.
Medicaid is one of the major payers for mental health services in this country. They don’t get to set policy for facilities that don’t bill Medicaid, but there are very few facilities (excluding celebrity rehab spas) that can’t afford to not bill Medicaid. This policy was designed to keep states from closing their state hospitals and long term mental health care facilities and dumping those people onto the Federally paid for portion of Medicaid. The side effect is the facilities that are out there are artificially limited to sixteen beds or less. There are a couple of work-arounds (mainly defining how multiple 16 bed pods are seperate facilities) but there are significant limitations on facilities.
So to recap; in patient rehabilitation and detox services have historically been seen as mental health services which means sporadic coverage at low rates. That is slowly changing. And those providers which do rehab and detox are limited to small facilities. More people have access to these services without supply increasing. And since John is usually a a functional individual on most measures (excluding mopping), he does not need emergency admittance, so he is getting fucked because there are nowhere near enough beds to help the people who need help but can get by at a lower quality of health and living without the service.
How do you feel about the Priority Groups in the VA Health System?
@raven: I don’t know anything about Priority Groups, so I don’t have an opinion.
another Holocene human
The states closed their facilities anyway so the joke’s on us.
Once the crazy person in homeless and has been dragged into court a few times they no longer count as human and we no longer have to care. Low taxes!
@another Holocene human: Saint Ronnie started that here in CA, along with an assist from liberals. Institutionalization was awful back then but just releasing folk onto the streets wasn’t a solution. But lower taxes!!!
@Richard Mayhew: http://www.va.gov/healthbenefits/resources/priority_groups.asp
This is just such a sad situation that will be resolved soon. John wants and needs help and if he receives the care he needs, his overall health will improve. It just shouldn’t be this hard.
Don’t be glum. Sounds like we’ve just discovered a growth industry, where investment now will pay off when stress finally gets us.
In fact, the whole system has evolved in the context of laws which treat addicts as human failures who do not deserve treatment. They deserve blame, scorn, punishment, and rebuke for their moral failings.
Our son is a homeless alcoholic, with one conviction for felony drugs on his record, a conviction he never was even required to serve time for.
But as a result, he cannot even qualify for food stamps. Or vote.
No, rehabilitation is something that the moralists making these laws do not even believe in. They believe in punishing you, then kicking you while they hold you down, so that you can never get up again.
Did I mention I hate their ******** guts? Because I have seen what it does to our son, and his friends who are in similar circumstances, living on the street, and trapped in a vicious cycle from which there is no escape, and no help for escape, or even belief that there should be help for escape.
Raygun and the right-wing shitheads achieve their goal again of fucking everyone in the middle class and poor.
thanks for another informative post.
I’m so sorry that your son is going through this. I get %^%$%$%^^&&* pissed about it, too. It doesn’t have to be this way and especially when it is usually the supposed Christians calling for the judging and punishing for life completely against Christian teachings–it makes it even more disgusting.
John wants to go to rehab system says no, no, no.
The lower taxes part is the killer.
Mental health advocates wanted a better way to care for the mentally ill, such as community based treatment, i.e. they live in your neighborhood.
Between NIMBYism, for those who could afford it, and tax cuts, the money for that approach was not there and the mental health advocates basically got played for chumps by politicians looking for an excuse to cut state budgets and lower taxes.
It’s a sad cycle in this country, where advocates for attempting positive reforms in a government run system get played for chumps by politicians – usually right-wing politicians, from what I’ve seen, but I maybe biased – who are interested in funneling money to the rich and well connected or it is not worth the government’s time to do it.
You can see this with the charter school movement over the last 25 years. Education experts wanted charter schools to either be experimental schools within the public school framework or some type of private school, with different education methodologies to see if there’s a better way to educate students. They did not expect folks to see dollar signs in the program and turn into a for profit enterprise.
If there’s ever a segment of the economy that would benefit from more money it is mental health services. The pay for people in mental health is pathetic. They get clumped into the sort of “bleeding heart sucker professionals”, who do a job because they care and not solely for the money, which I would put in with teachers, social workers and others, who do not make anywhere near enough for the work they do.
Mental health workers go beyond just psychiatrists and therapists. It includes nurses, social workers – to coordinate where people, with no place to go will go after getting released – the people, who actually run half-way houses and other group homes for the mentally ill, as well as case workers – in places that actually spend the money to have them – who follow up with people released from state institutions to make sure they do not relapse, i.e. get back on using drugs.
The books of David Sheff deal with treatment in this country, sometimes in the context of his son’s addiction. He says there is no single researched and proven method and treatment centers usually reflect the philosophies of the director.
Mr Stagger Lee
Right now, I am listening to Amy Winehouse’s Rehab, if she was an American in John ‘s shoes, I bet the lyrics would have been
@another Holocene human:
Even in the “glory days” of institutionalizing folks for the rest of their lives, there would not have been a place for John G. Cole. Those beds were reserved for folks, who were not coming out again.
Rehab centers seem to always have been either ridiculously expensive, so only the rich can afford to get care on demand or basically unavailable for the rest of us, because of scarcity.
THis is an interesting and timely (if unfortunate for John – sorry man, it sucks when you can;t get the help you need)
A very close friend of mine had pretty much the exact same problem, and despite the fact that she worked in the healthcare field, she was still shocked when the people at the various facilities she called would tell her that he problem wasn’t serious enough to even get on their waiting list (in her case it was prescription painkillers after surgery)
One nurse, when she found out the dosage she was taking, actually laughed at her and told her to just” suck it up and quit”, or maybe call back when she was taking 5 times as much
@HeartlandLiberal: I’m so sorry about that.
From an admittedly very macro perspective, my dream is the Assisted Living for Everyone! plan.
Kids with a lousy home life, teens kicked out because parents don’t think they need to raise them any more, young adults without the skills, people with any kind of health issues, and the just plain Logic Challenged… let them have a cooperative with concentric rings of freedom and responsibility, trained supervision, fees on a sliding scale, and professionals to come by and weed out the psychos and sociopaths and leeches. Some would graduate, some would not. Those who could help run the place, would.
Oh, but that would be so expensive…
Not nearly as expensive as our current system of prisons, treatment facilities, and juvenile homes. It could all be ours. If we want to make sense.
Anyone looking for rehab services should start here:
I’ve forgotten where JC lives, but I put Berkeley Springs,WV in the locater and it threw up 12 facilities within 25 miles. Clicking on the facilities will give you a description of the type of services they offer. Some are mental health facilities and some are rehab. Every doc should be familiar with this website!
What about Passages Malibu? They got acupuncture, massages, frolicking….the owner was an addict for 10 years, you know.
Reading material for the meantime.
As one Amazon reviewer said:
“This book presents common-sense methods for changing your life, essentially by beginning to live the life you want to live eventually. It’s not the single best thing I ever read, but it’s a breath of fresh air compared to the dreary old advice to abase yourself, label yourself defective and diseased, and turn your entire life over to “God as we understood Him.”
If you’re a devoted 12-stepper, this may anger or even frighten you. If you’re looking for a more positive approach which doesn’t condemn you to obsessing over alcohol for the rest of your life, you might like this. It’s certainly worth a read.”
I’m a fan of Scott Miller, he’s a proponent of judging therapeutic interventions based on their outcome. (I’m also a fan of Insoo Kim Berg’s solution focused approaches.)
Here’s a powerpoint from miller on what works in SA.
@HeartlandLiberal: I am so sorry that you are going through this. It is hard enough to love and deal with an addict but to have to deal a system in place that at best is inconsistent and at worse is negligent and indifferent is pure hell.
Your estimation of this is a bit on the lite side. Negligent and indifferent would be a huge improvement. The situation in this country is far worse than that, with that old puritan ethic of “If you don’t fit in we will vilify you to death” being the norm.
Many here have touched on several of the issues which make the situation far worse in total. Starting with insurance, because we are all built a bit different in the head department, the same treatment doesn’t always work so how does insurance pay for this? How many treatments, what type, how do you measure effectiveness? Next, if you were trying to make a class of people to lord over your greatness on you couldn’t design a better system than our mental health system. Not that most of the people working in the field aren’t trying to help, but it’s low paying(see insurance above), if you are barely or moderately functional your chances of having insurance or even a decent job goes way down. So we have a society that puts the onus on being well and fitting in totally on the individual just at a time when that is next to or actually impossible. Somewhat like abortion, if you have money there is no problem getting help, otherwise fuck you.
We need a new list of priorities. We’d be a better country and a better society for it. What gets me is people still want to move here. Life must really suck in some places in this world.
Repeating a comment from the previous thread about rehab facilities:
John, you probably don’t want to travel this far, but Seattle has Schick Shadel. It’s a very expensive, very effective 10-day program that uses aversion therapy.
Here is a diary from someone who went through the treatment:
A friend of mine went through the treatment and it worked like a charm.
The downside is I think there are only two facilities in the whole country, Seattle and Texas, though one in Florida is supposed to open this month. If you come to Seattle, there are local BJers who would be happy to see you and offer morale support.
My SO went to a 28-day program but she spent three months on the phone with her doctor and the insurance company. Her doctor helped make it happen. Once the insurance company agreed, she had a choice of two nearby 28-day programs centers to choose from. Insurance also paid for a year of intensive outpatient care and counseling. The cost is considerable, the insurance coverage was a life saver. It’s hard to imagine people returning for treatment two, three or more times.
I know you’re paraphrasing and simplifying, but there’s no single researched and proven method of treatment for any mental illness. Not depression, not bipolar, not schizophrenia. So why would addiction treatment have a magic one-size-fits-all solution?
I have seen the 12 steps work wonders with several people in my life but the people that it works for seem to have an almost OCD-like compulsive streak that leads them down the road of excess in most areas of their lives, even things that are otherwise “healthy,” like their eating habits or exercise routine. The constant going to meetings and monitoring themselves is good for them because otherwise their compulsive streak only leads them to switch their obsession from drinking to, say, overexercising, and then they blow out their knee from overuse.
Enhanced Voting Techniques
@HeartlandLiberal: I would say Heartland’s story is what’s going on here; addicts are just another group of “others” for the conservatives to single out for abuse.
Not to mention the War on Drugs needs its criminal class to justify it’s budget.
I would not say life sucks, but there are more opportunities here than in other parts of the world. And the U.S. is a lot less polluted than say China or India, which improves the quality of life.
Also, the USA is very welcoming of immigrants, when compared with Europe, for example, where immigrants have no means to citizenship in some countries and birthright citizenship does not exist.
Ed in NJ
While I appreciate Richard’s perspective on how recent policy has contributed to John’s issues with finding help, I think the issue has been building for much longer. As a recent grad, I worked as a mental health assistant in a very well know rehab here in NJ that no longer exists, partly because the insurance companies stopped reimbursing for what in the early 80s were up to 6 months of inpatient stays. Back then, you would often see diagnoses of depression, anxiety, bipolar disorder, etc. used as the justification for extended stays in what was mostly a 12-step based inpatient program with a little med management thrown in. But that model didn’t last long. When the insurance companies caught on the model shifted to one where the average stay was more like a month, followed by outpatient group day treatment for a few months, and then individual counseling for many months afterwards. Then the insurance companies stopped paying for all inpatient rehab except for acute stabilization and detox services. The average stays were now about a week unless there were serious mental or physical issues.
Once the long-term rehab model went away, facilities started to close, replaced by a glut of outpatient treatment centers that relied on acute care stepping down patients into their programs.
But at every step of the way, the system has always relied on the situation getting so bad an inpatient stay was needed before intensive help was available. Sad to say, but I suspect as a functional alcoholic, John may not seem “sick” enough to warrant the care he desires. Most insurance companies want to prescribe the least invasive, most cost effective treatment to start, and providers follow their lead, starting with individual or group outpatient and only providing rehab if there are serious mental, physical, or legal issues associated with the addictive behavior. Sticking to the disease model, it’s as if someone was denied chemo until their tumor became life threatening.
Not sure what the answer is, outside of self-funding treatment. But of course there is a reason only rich and famous people wind up at Promises, Betty Ford, or the Dunes.
@Ruckus: that is what I meant. I was just focused on the awful situation that poster is in.
@canegiallo: Thank you for that link!!
@WereBear: Your assisted living plan for everyone – I would gladly pay taxes for that. There are beautiful people who want to go into helping professions and beautiful people needing help. I wish we had a system that supports them.
Well, Tennessee’s solution is to throw you in jail, if you’re poor. Alternately, you can be like the upper crust and get yourself a fancy “addiction concierge.”
This. According to a friend of mine who works with the homeless, a person who’s homeless at 18 and remains on the street will cost the system about $3 million over the course of their lives. But helping them get off the streets would be Sociamalism, and we can’t have that. Our country is nuts.
When the founders removed religion from the id of the country the god bothers of the day had to keep slipping it back in. They had a hard time on the federal level(not that they didn’t try) but on the local/state level they managed. And one of the biggest problems was the punishment method. If there is one sinner, everyone suffers for it. Ban whatever and the world will be well. You have a welfare cheat or two, get rid of the entire program. Someone on unemployment has figured out how to milk it, that’s the end of it. Some drink too much, prohibition. It is of course bullshit, and backfires badly for the problem is not everyone, it is those who don’t cope well. We could help those people but that would point out that their system isn’t perfect and therefore can’t stand.
So the god bothers we have, have (at the very least!) two problems, their system is very far from perfect and their punishment system for that lack of perfection is totally dysfunctional. Our problem is that this is baked into our culture.
treatment for addiction is shoddy, hard to find, and often, even harder to sustain beyond the treatment environment. I’ve been clean and sober a while now (since 92), and it remains the single best thing I’ve done in my adult life. every positive achievement in every other aspect stems from that decision to get sober and remain so.
it all starts with stopping. stopping now. then there are those stupid, annoying meetings. much as I hate them most of the time, it is the only thing that has ever worked for me.
unless there are medical reasons for stopping in a treatment environment you can do this on the outside. since that’s where you’re going to have to live eventually it makes sense. find the closest AA meeting and go there john. tell people about your struggle right now. then, let them help you. they will line up to help you because their own sobriety and lives depend on being ready and willing to give you that help.
I tell people who are starting out to “get the book. do what it says.”
the current model for treatment from the addiction medicine folks is to detox, then pat them on the head and tell them to go to meetings.
try anything, and everything right now. if you send me a friend request on facebook, or drop me an email I will help you in any way that I can.
Just want to note that while we’re continuing the decades-long “tradition” of gutting addiction and mental-health support and treatment, we continue to work overtime ensuring these folks have unfettered access to firearms.
J R in WV
Yes, the Godbotherers are still with us, and more powerful than they have been in a long time.
Puritanism is a big part of why the First Amendment addresses religious freedom by prohibiting the government from supporting any religion. If it wasn’t for that simple sentence in the constitution we would all be evangelistic Fundy Protestants, or imprisoned on a work camp until we manage to find Jesus in our hearts.
The other important religious statement in the constitution prohibits any religious test for government office,
and I think this is at least as important as the First Amendment. Given these founding document statements, I am totally baffled by those who want to attempt to prove that we live in a “Christian nation”! We don’t, we never have, get over it.
But the immorality of indulging in something just because it makes you feel good… isn’t feeling good something we’re supposed to strive for?
People go on and on about addiction, and absurd controls are imposed to try to prevent addiction. One problem with this approach is that many people seem to be able to become addicted to almost anything, like Big Mac burgers, for FSM’s sake!
If pharmaceutical heroin was legal, monitored, and inexpensive, what would it matter if someone became addicted to something that cost less than a Mountain Dew habit? Particularly if rehab was also inexpensive and widely available for those who tire of their specific addiction.
A good friend is somewhat disabled by repeated motor vehicle accidents – not her fault, rear ended once, a passenger in a vehicle that wrecked on the Interstate, etc. Painkillers are part of her life. Now that there is a booming black market, “They” are making it more and more difficult to obtain prescription pain killers, even for someone who uses them appropriately at about half the prescribed dose levels.
I think the only solution to the Drug War and NarcoTerrorism is the legalization of all substances for any purpose. Along with this, I would advocate the ban of all advertising for any thing that shows addictive behavior in even a small sub-population, or that has any medical effects. So this would include advertising for smack, special k, ecstasy, gambling, soda pop, cannabis, etc. All of these things should be inexpensive, just like prescription drugs should be free, or nominally priced with… wait a minute, no prescriptions any more.
See how culture affects our viewpoint? I’m busy making a case for legalizing drugs, and I’m assuming that prescriptions will still exist! Maybe they should, and maybe chemo should still be administered at treatment centers. Obviously there’s a lot to work out here.
But as long as we attempt to shape people’s lives by prohibition, of Cannabis or any other drug, that’s how long we have to live with NarcoTerrorism. Just wait until it comes to America! Right now it’s in Central America, but nothing is going to stop it from coming home, just like it did in the first noble experiment, Prohibition of Alcohol back in the early days of the last century.
By the way, who ever it was who said most Republicans, if you gave them a map and asked them to show you Central America, they would put their finger down on Nebraska, that’s such a great line. It wraps up so much error-prone thinking into one sentence! Thank you for that insight, and the very funny statement wrapping it up for us to remember it by.
John, there’s a facility in Charleston, WV called Highland Hospital, that may be good for you. Charleston is a pretty nice small city. CAMC also does inpatient treatment. I see from the search tool that WVU Hospital does too. Keep up your fight, don’t give up just because cultural norms are warped to inhibit your treatment!
@Ed in NJ: Sorry, I mostly lurk, but this post requires a little more smoke screen than usual.
A coworker of mine went to rehab voluntarily last year to get off prescription pain pills that he had been on for many years. It’s a long story, he was quite functional, but multiple doctor screwups* put him in a position where he thought he’d be better off going through rehab than trying cold turkey or tapering on his own. Well, it seems that it basically turned into a psuedo tough love version of hell. He was in “class” from 7am to 7pm with screeds and harangues about worthlessness and how to live sober. Trick is that most people were there on court order for criminal heroin relalted offenses. Then the fun began with the real withdrawal. He has serious underlying health problems, including diabetes and asthma, but wasn’t allowed to take ANY of the necessary meds without getting himself to the main desk on schedule, because it was ALL considered enabling. Oh, and he couldn’t have his cane, because that would be a weapon. In addition to hallucinations, he ended up experiencing seizures, serious blood sugar, electrolyte and other imbalances. Blood pressure skyrocketed and he ended up being put into an ambulance to the nearest hospital (well over 45 minutes by ambulance though the Kentucky boondocks). After they got him stabilized, he was sent back to rehab, where there was still no actual healthcare happening. You can’t walk to the desk, you can’t get your meds. You can’t control your bodily functions while you seizure, and you can’t get to the desk to get new sheets, sucks to be you. So again, he ended back up in the ambulance to the hospital after he was found on the hallway floor one night somewhere between unconscious and raving with a heart rate through the roof. With that second ER trip, they just released him, didn’t tell him, just gave his phone and other belongings to the EMTS. The hospital gave him some meds to ease the withdrawal, address his other issues and he spent a few days there. So rehab in this version is cold turkey without support. He wasn’t in there for an arrest or illegality, he thought he was doing the right thing. FSM, fucking no one deserves to be treated like that, including anyone there after arrest or court order. It’s just punishment, pure and simple, not health care. Yes, he knew something had to change, but this was the best(only) facility he could find with his wife’s super plus platinum insurance plan. Good insurance and ability to pay didn’t matter. Hell, it’s the only damn facility in a 150 mile radius. Rehab, my ass.
*If you are getting drug tested for any reason do not forget to list that stupid pocket Vick’s nasal inhaler and its ingredients if you use it. It apparently contains something chemically similar to meth that they need to order a more comprehensive test set for to determine the difference, but hey why bother with that request when they can just release the patient. Yes, there are lawyers involved in this part of coworker’s life. He spent many dollars getting extensive hair testing done as this is why his doc had dismissed him as a patient. Oh, and don’t get the idea that I’m snowed because I like him. We get along, but lordy, he’s a flaming teabagger, and even this site makes me look like a pinko sometimes. This kind of crap should not happen to anyone, and if it’s happening to white privileged people, it only tells me that everyone else has it worse.
I worked for a rehab facility with exactly 16 beds for years. Still work n with them for some clients. It’s a confusing mess to bill just about any insurance company for enough to keep the lights on.
@J R in WV:
Here’s the problem, though — for a lot of people, rehab doesn’t work. So now by having legalized heroin available at the corner store, you’re basically creating an unnecessary public health crisis. Even countries that have “legalized” heroin usually make existing addicts come to a medical facility to get their maintenance dose and use it there under supervision so they don’t accidentally kill themselves.
I know that years of “Just Say NO!” harangues about marijuana being a “gateway drug” have made people think that all drugs are equally as benign, but it’s not the case. Opiates are seriously fucking dangerous stuff that will kill you. Read about the massive opiate addictions in the US after the US Civil War — it was a major public health problem, in part because it was all perfectly legal.
Also, AA and the rehab industry spend lots of time and money trying to convince people they are addicts because rehab in America is a for-profit concern and they want beds full. Also the courts and employers are constantly ordering people to rehab as a way to reduce a sentence or keep a job. So rehab is full of thousands of people who have no business being there at all because they are not drunks, or addicts, they are just people with a DUI or who didn’t pass a drug screening at work because they smoked some weed the weekend before. CA recently closed 235 rehab centers that were basically scamming the State by convincing people that they were addicts then collecting State funds for treating them. Until we get the for-profit motive out of it, until we get self-serving groups like AA out of it, this problem will not go away.
My name is glocksman* and I am an Alcoholic.
That said, AA is an incredibly useful resource for alcoholics who have a spiritual bent.
Unfortunately, I don’t have much of a spiritual bent, and most of the AA experience was lost on me.
Though I will say that every addict/alcoholic stands to benefit from the listing of your defects of character.
Is AA the only answer?
Of course not. We alcoholics vary in character/beliefs/code of ethics as the non-alcoholic community does.
I didn’t get much from AA as a whole, but there are parts in their program that do help.
*I’m somewhat reluctant to broadcast my real name over teh intertubes, but if doing so helps other alcoholics ‘out’ themselves as part of their recovery, I’ll do it.
Though I would remind those who hate me that I still possess a legal Indiana LCTH and that I plan on buying a Ruger LCR in the next couple of months. :)